Summary & Overview
CPT 97150: Group Therapeutic Procedures in Physical Medicine and Rehabilitation
CPT code 97150 represents group therapeutic procedures performed by physical medicine and rehabilitation professionals for two or more individuals. This code is widely used in outpatient therapy settings, such as physical therapy clinics, to deliver rehabilitation services in a group format. The procedure is essential for addressing a variety of musculoskeletal and functional impairments, including conditions like low back pain, knee pain, difficulty walking, and muscle weakness.
Major national payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a comprehensive overview of payer coverage, policy updates, and clinical benchmarks relevant to CPT 97150. Readers will gain insight into the clinical context of group therapeutic procedures, common billing modifiers such as 59 and 76, and associated provider taxonomies. Additionally, the report highlights related CPT codes and typical ICD-10 diagnoses encountered in group therapy settings.
This summary serves as a resource for understanding the national landscape of group therapeutic procedure billing, payer policies, and clinical applications. It is intended for healthcare administrators, billing professionals, and clinical leaders seeking clarity on coding, coverage, and operational considerations for CPT 97150.
CPT Code Overview
CPT 97150 is defined as Therapeutic procedure(s), group (2 or more individuals). This code is used in the context of Physical Medicine and Rehabilitation Therapeutic Procedures, specifically when therapy is provided to multiple patients simultaneously. The typical site of service for CPT 97150 is an outpatient therapy setting, such as a physical therapy outpatient clinic. This group therapy approach is designed to facilitate rehabilitation and therapeutic interventions in a collaborative environment, supporting patients with a range of musculoskeletal and functional conditions.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves a group of patients attending an outpatient physical therapy clinic for rehabilitation. Each patient presents with musculoskeletal or mobility issues, such as low back pain, knee pain, difficulty walking, or generalized muscle weakness. The physical therapist leads a group session, providing therapeutic procedures tailored to the needs of two or more individuals. The session focuses on improving mobility, strength, and functional abilities through guided exercises and activities. Documentation includes the number of participants, the therapeutic interventions performed, and the clinical rationale for group therapy.
Coding Specifications
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Modifiers:
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Modifier
59: Distinct Procedural Service. Used when group therapy (97150) is performed separately from other procedures on the same day, indicating it is a distinct service. -
Modifier
76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Used when group therapy (97150) is repeated for the same patient by the same provider on the same day.
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Provider Taxonomies:
Taxonomy Code Specialty Name 225100000XPhysical Therapist 225200000XPhysical Therapy Assistant 225400000XRehabilitation Practitioner
These taxonomies represent professionals qualified to deliver physical medicine and rehabilitation therapeutic procedures, including group therapy.
Related Diagnoses
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M54.5- Low back pain- Relevant for patients participating in group therapy to address pain, mobility, and functional limitations in the lumbar region.
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M25.561- Pain in right knee- Indicates patients with right knee pain who may benefit from group therapeutic procedures to improve joint function and reduce discomfort.
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M25.562- Pain in left knee- Applies to patients with left knee pain, suitable for group therapy aimed at enhancing mobility and strength.
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R26.2- Difficulty in walking, not elsewhere classified- Used for patients experiencing gait disturbances, where group therapy can help improve walking ability and balance.
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M62.81- Muscle weakness (generalized)- Pertains to patients with overall muscle weakness, for whom group therapy can facilitate strength and endurance training.
Related CPT Codes
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97110- Therapeutic exercise- Used for individualized therapeutic exercises to improve strength, range of motion, and flexibility. May be performed in conjunction with group therapy (
97150) or as an alternative when one-on-one care is needed.
- Used for individualized therapeutic exercises to improve strength, range of motion, and flexibility. May be performed in conjunction with group therapy (
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97112- Neuromuscular reeducation- Focuses on improving movement, balance, coordination, and proprioception. Can be used alongside group therapy (
97150) for patients with neuromuscular deficits.
- Focuses on improving movement, balance, coordination, and proprioception. Can be used alongside group therapy (
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97035- Ultrasound- Provides deep heat therapy to soft tissues. Often used as a preparatory or adjunct modality before or after group therapeutic procedures (
97150).
- Provides deep heat therapy to soft tissues. Often used as a preparatory or adjunct modality before or after group therapeutic procedures (
These codes are commonly used together in physical therapy workflows, depending on individual patient needs and treatment plans.
National Reimbursement Benchmarks
For CPT code 97150, national mean rates show that Medicare reimburses at $18.63, while the average commercial payer (BUCA) is higher at $20.78. Among individual commercial payers, Cigna has the highest mean rate at $26.23, and Aetna the lowest at $16.03.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range ($1.00), indicating minimal variation in rates. Cigna has the widest dispersion ($16.00), reflecting greater variability in commercial reimbursement. Blue Cross Blue Shield and UnitedHealth Group also show broader ranges ($9.14 and $7.00, respectively), while Aetna and BUCA are more moderate.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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